Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Surgical Endoscopy
Published in: Surgical Endoscopy 3/2015

01-03-2015

Timing of esophageal stent placement and outcomes in patients with esophageal perforation: a single-center experience

Authors: Udayakumar Navaneethan, Vennisvasanth Lourdusamy, Sudhir Duvuru, Dennisdhilak Lourdusamy, Dhruv Mehta, Siva Raja, Sudhish Murthy, Madhusudhan R. Sanaka

Published in: Surgical Endoscopy | Issue 3/2015

Login to get access

Abstract

Background

Endoscopic treatment for esophageal perforation with stenting is an alternative to surgery. There is no data on the impact of timing of esophageal stent placement and outcomes in patients with esophageal perforation.

Objective

To determine the significance of timing of esophageal stent placement on short-term (30-day complications) and long-term clinical outcomes of patients with esophageal perforation.

Methods

Patients with esophageal perforations who underwent endoscopic treatment with stenting from 2007 to 2012 at the Cleveland Clinic were included for the study. Main outcomes measurements were impact of time to esophageal stent placement on 30-day complications and long-term outcomes.

Results

A total of 20 patients (males 40 % and females 60 %) were included. Mean age was 72.5 ± 10 years. The most common etiology for perforation was iatrogenic after endoscopy procedure in 10 (50 %) patients. The stent was in place for a median of 24.6 days in our cohort. Eight patients (40 %) had stent placement within 24 h, while the remaining 12 patients (60 %) had stent placement after 24 h. The mortality rate due to perforation related causes was 10 % (2/20) in our study. The 30-day complication rate was 10 %; 1 with stent migration and the other with chest pain. The 30-day readmission rates excluding patients who died during the initial hospitalization were 10 %. On long-term follow-up, 30 % complication rates were encountered; 3 (15 %) stent migrations, 2 (10 %) patients presented with hematemesis, and 1 (5 %) with chest pain. The timing of stent placement (within 24 h or later) did not impact the risk of complications (Odds Ratio [OR] 1.13, 95 % confidence interval 0.1–8.9, P = 0.91).

Conclusions

Endoscopic stent placement is safe and effective for treating esophageal perforations. However, the timing of stent placement on outcomes remains unclear.
Literature
1.
Fischer A, Thomusch O, Benz S, von Dobschuetz E, Baier P, Hopt UT (2006) Nonoperative treatment of 15 benign esophageal perforations with self-expandable covered metal stents. Ann Thorac Surg 81(2):467–472PubMedCrossRef
2.
Schweigert M, Dubecz A, Solymosi N, Ofner D, Stein HJ (2013) Times and trends in the treatment of spontaneous perforation of the esophagus: from Herman Boerhaave to the present age. Am Surg 79(9):902–908PubMed
3.
4.
Siersema PD, Homs MY, Haringsma J, Tilanus HW, Kuipers EJ (2003) Use of large-diameter metallic stents to seal traumatic nonmalignant perforations of the esophagus. Gastrointest Endosc 58(3):356–361PubMedCrossRef
5.
El Hajj II, Imperiale TF, Rex DK, Ballard D, Kesler KA, Birdas TJ, Fatima H, Kessler WR, Dewitt JM (2013) Treatment of esophageal leaks, fistulae, and perforations with temporary stents: evaluation of efficacy, adverse events, and factors associated with successful outcomes. Gastrointest Endosc. doi:10.​1016/​j.​gie.​2013.​08.​039
6.
Swinnen J, Eisendrath P, Rigaux J, Kahegeshe L, Lemmers A, Le Moine O, Devière J (2011) Self-expandable metal stents for the treatment of benign upper GI leaks and perforations. Gastrointest Endosc 73(5):890–899PubMedCrossRef
7.
Salminen P, Gullichsen R, Laine S (2009) Use of self-expandable metal stents for the treatment of esophageal perforations and anastomotic leaks. Surg Endosc 23(7):1526–1530PubMedCrossRef
8.
Ben-Menachem T, Decker GA, Early DS, Evans J, Fanelli RD, Fisher DA, Fisher L, Fukami N, Hwang JH, Ikenberry SO, Jain R, Jue TL, Khan KM, Krinsky ML, Malpas PM, Maple JT, Sharaf RN, Dominitz JA, Cash BD (2012) Adverse events of upper GI endoscopy. Gastrointest Endosc 76(4):707–718PubMedCrossRef
9.
Johnsson E, Lundell L, Liedman B (2005) Sealing of esophageal perforation or ruptures with expandable metallic stents: a prospective controlled study on treatment efficacy and limitations. Dis Esophagus 18(4):262–266PubMedCrossRef
10.
Eubanks PJ, Hu E, Nguyen D, Procaccino F, Eysselein VE, Klein SR (1999) Case of Boerhaave’s syndrome successfully treated with a self-expandable metallic stent. Gastrointest Endosc 49(6):780–783PubMedCrossRef
11.
Bufkin BL, Miller JI Jr, Mansour KA (1996) Esophageal perforation: emphasis on management. Ann Thorac Surg 61(5):1447–1451PubMedCrossRef
12.
Kuppusamy MK, Hubka M, Felisky CD, Carrott P, Kline EM, Koehler RP, Low DE (2011) Evolving management strategies in esophageal perforation: surgeons using nonoperative techniques to improve outcomes. J Am Coll Surg 213(1):164–171; discussion 171–172
13.
van Boeckel PG, Dua KS, Weusten BL, Schmits RJ, Surapaneni N, Timmer R, Vleggaar FP, Siersema PD (2012) Fully covered self-expandable metal stents (SEMS), partially covered SEMS and self-expandable plastic stents for the treatment of benign esophageal ruptures and anastomotic leaks. BMC Gastroenterol 29(12):19. doi:10.​1186/​1471-230X-12-19 CrossRef
14.
Leers JM, Vivaldi C, Schäfer H, Bludau M, Brabender J, Lurje G, Herbold T, Hölscher AH, Metzger R (2009) Endoscopic therapy for esophageal perforation or anastomotic leak with a self-expandable metallic stent. Surg Endosc 23(10):2258–2262PubMedCrossRef
15.
Freeman RK, Van Woerkom JM, Ascioti AJ (2007) Esophageal stent placement for the treatment of iatrogenic intrathoracic esophageal perforation. Ann Thorac Surg 83(6):2003–2007PubMedCrossRef
16.
17.
Cameron JL, Kieffer RF, Hendrix TR, Mehigan DG, Baker RR (1979) Selective nonoperative management of contained intra-thoracic esophageal disruptions. Ann Thorac Surg 27:404–408PubMedCrossRef
18.
Vanuytsel T, Lerut T, Coosemans W, Vanbeckevoort D, Blondeau K, Boeckxstaens G et al (2012) Conservative management of esophageal perforations during pneumatic dilation for idiopathic esophageal achalasia. Clin Gastroenterol Hepatol 10:142–149PubMedCrossRef
19.
Biancari F, Saarnio J, Mennander A, Hypén L, Salminen P, Kuttila K, Victorzon M, Böckelman C, Tarantino E, Tiffet O, Koivukangas V, Søreide JA, Viste A, Bonavina L, Vidarsdóttir H, Gudbjartsson T (2014) Outcome of patients with esophageal perforations: a multicenter study. World J Surg 38(4):902–909. doi:10.​1007/​s00268-013-2312-2
20.
21.
Abbas G, Schuchert MJ, Pettiford BL, Pennathur A, Landreneau J, Luketich JD et al (2009) Contemporaneous management of esophageal perforation. Surgery 146:749–755PubMedCrossRef
22.
Hermansson M, Johansson J, Gudbjartsson T, Hambreus G, Jonsson P, Lillo-Gil R et al (2010) Esophageal perforation in south of Sweden: results of surgical treatment in 125 consecutive patients. BMC Surg 10:31PubMedCentralPubMedCrossRef
23.
Wahed S, Dent B, Jones R, Griffin SM (2014) Spectrum of oesophageal perforations and their influence on management. Br J Surg 101:e156–e162PubMedCrossRef
24.
Muir AD, White J, McGuigan JA, McManus KG, Graham AN (2003) Treatment and outcomes of oesophageal perforation in a tertiary referral centre. Eur J Cardiothorac Surg 23(5):799–804PubMedCrossRef
25.
Biancari F, D’Andrea V, Paone R, Di Marco C, Savino G, Koivukangas V, Saarnio J, Lucenteforte E (2013) Current treatment and outcome of esophageal perforations in adults: systematic review and meta-analysis of 75 studies. World J Surg 37(5):1051–1059. doi:10.​1007/​s00268-013-1951-7 PubMedCrossRef
26.
Freeman RK, Ascioti AJ, Giannini T, Mahidhara RJ (2012) Analysis of unsuccessful esophageal stent placements for esophageal perforation, fistula, or anastomotic leak. Ann Thorac Surg 94(3):959–964; discussion 964–965
Metadata
Title
Timing of esophageal stent placement and outcomes in patients with esophageal perforation: a single-center experience
Authors
Udayakumar Navaneethan
Vennisvasanth Lourdusamy
Sudhir Duvuru
Dennisdhilak Lourdusamy
Dhruv Mehta
Siva Raja
Sudhish Murthy
Madhusudhan R. Sanaka
Publication date
01-03-2015
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 3/2015
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-014-3724-2

Other articles of this Issue 3/2015

Surgical Endoscopy 3/2015 Go to the issue

OriginalPaper

Early human experience with per-oral endoscopic pyloromyotomy (POP)

OriginalPaper

Esophagogastric junction distensibility measurements during Heller myotomy and POEM for achalasia predict postoperative symptomatic outcomes

OriginalPaper

Potential advantages of robotic radical gastrectomy for gastric adenocarcinoma in comparison with conventional laparoscopic approach: a single institutional retrospective comparative cohort study

OriginalPaper

Long-term mortality rates (>8-year) improve as compared to the general and obese population following bariatric surgery

Erratum

Erratum to: Liquid-injection for preperitoneal dissection of transabdominal preperitoneal (TAPP) inguinal hernia repair

OriginalPaper

Reoperation rates after laparoscopic fundoplication